Local Sales Tax Return Form - City Of Bloomington - 2015
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12015 Local Sales Tax Return
These taxes are mandated by Bloomington City Code, Chapter 4
Checks payable to the “City of Bloomington.” Mail two copies to the Accounting Division at the address below.
Payments can also be made by ACH credit. Please e-mail
llatax@BloomingtonMN.gov
or call 952-563-4763 for instructions.
Establishment Name
(Not Corporate Name)
Mailing Address:
Street
Minnesota Sales Tax
Account Number (7 Digits)
City
State
Zip
Minnesota Sales Tax
Period End Date
Due Date
/
/
/
/
Your return must be postmarked by the 20th or received in our office by the 25th day of your City approved accounting period.
LIQUOR TAX
Office Use Only
1
Total Taxable Liquor Sales
LIQUOR TAX
2
4300-41402(06)
Liquor Tax Due
Line 1 X 3%.
0.00
LODGING TAX
LODGING TAX
3
4300-41403(60)
Gross Lodging Sales
4
Written leases for 30 days or more and
1001-41403(61)
Less: Exclusions
other tax exempt lodgings per City Code.
5
8150-20299(65)
Total Taxable Lodging Sales
Line 3 - Line 4.
0.00
6
Lodging Tax Due
Line 5 X 7%.
0.00
ADMISSION TAX
ADMISSION TAX
7
Total Taxable Admission Sales
8
1001-41401 (62)
Admission Tax Due
Line 7 X 3%.
0.00
TOTAL TAXES, PENALTIES AND INTEREST
Notes:
9
TOTAL LOCAL TAXES DUE
Line 2 + Line 6 + Line 8.
0.00
10
5% Penalty
If payment is not made by date due, Line 9 X 5%.
11
If payment is not made within 30 days after date
10% Penalty
due, (Line 9 + Line 10) X 10%.
If payment is not made by date due, (Line 9 + Line
PENALTIES AND INTEREST
12
5% Interest
÷
10 + Line 11) X 5% X (Days past date due
360).
13
1001-41404 (63)
Total Penalties and Interest
Line 10 + Line 11 + Line 12.
0.00
14
TOTAL AMOUNT DUE
Line 9 + Line 13.
0.00
I declare and certify under penalty of law that I have examined this statement and that to the
best of my knowledge and belief, it is true and complete.
Signature _________________________________________ Title (Print) _____________________________________
Name of Preparer (Print) __________________________________________ Date ____________________________
Phone ____________________________________________ E-mail _________________________________________
Finance Department
Accounting Division
PH
952-563-4763
E-MAIL
llatax@BloomingtonMN.gov
1800 W. Old Shakopee Road
FAX
952-563-8789
BloomingtonMN.gov
Bloomington MN 55431-3027
TTY
952-563-8740
34_002 page1 (02/15)
Click to SUBMIT FORM by E-mail (Only if paying via ACH Credit)
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